목적: 최근 짧은 기간 동안 메타졸라마이드 복용 후 발생한 스티븐스-존슨 증후군 3예를 경험하였기에 보고하고자 한다. 증례요약: 29세 남자 환자와 47세 여자 환자로 개인 안과에서 중심성 장액성맥락망막병증 진단하에 메타졸라마이드(메조민Ⓡ, 비씨월드 제약)를 1정 하루 2차례(100 mg/일) 처방받아 복용한 다음, 전신의 가려움을 동반한 홍반성 반점 및 구진 발생하였다. 66세 여자 환자는 우안의 일차성 개방각 녹내장으로 타 대학병원에서 안압 조절을 위해 메타졸라마이드 복용 후 전신의 다형성 홍반 발생하였다. 환자들의 약물 복용력 및 특징적인 전신 피부 병변 및 점막침윤 소견으로 스티븐스-존슨 증후군으로 진단하였다. 세 환자 모두 피부과 입원 후 전신 스테로이드 및 항히스타민 치료를 받았으며, 안과적으로는 2예에서 결막에 가성막이 관찰되었다. 2예에서는 초기 발생한 피부병변 이 심해진 후 점차 호전을 보였고, 1예에서 독성표피융해로 진행하여 IV immunoglobulin 치료를 시행하였다. 3예 모두에서 HLA A24, B59, Cw1이 발견되었다. 결론: 최근 아세타졸라마이드의 생산 중단으로 인해, 경구 탄산탈수효소억제제로서 국내에서 유일하게 사용 가능한 메타졸라마이드에 의해 스티븐스-존슨 증후군이 발생한 경우로, 최근 한 달 이내에 특정 지역에서 발생한 증례들이다. 따라서 약제 사용시 보다 높은 주의가 필요 하며, 사용 전 자세한 부작용 설명과 고위험군에 대한 선별검사 등이 필요하리라 사료된다.

Purpose: To report three consecutive cases of methazolamide-induced Stevens-Johnson syndrome. Case summary: We describe three patients who were all prescribed methazolamide for treatment of ophthalmologic conditions. A 29-year-old man and a 47- year-old woman were prescribed methazolamide (100 mg/day) for the treatment of central serous chorioretinopathy (CSCR). A 66-year-old woman was prescribed methazolamide (100 mg/day) for acute glaucoma of the left eye for approximately two weeks. After taking the methazolamide, three patients were showed the pururitic maculopapular rashes on the whole body and the vesicular eruptions of the oral mucosa and conjunctiva. On the basis of medication histories, characteristic skin lesions and mucosal involvement, we diagnosed all three patients with methazolamide-induced Stevens-Johnson syndrome. All three patients were hospitalized and treated with intravenous steroids and antihistamines. Two of the three cases showed conjunctival pseudomembranes. In two cases, the skin lesions worsened during the first week of treatment, and then resolved without complications over the next two to three weeks. The condition of the 47-year-old female patient deteriorated rapidly to toxic epidermal necrolysis due to sensitivity to sulfa antibiotics. HLA- A24, B59 and Cw1 were detected in all three cases. Conclusions: In 2008, domestic production of acetazolamide was halted in Korea. Because of this, methazolamide is expected to be prescribed by ophthalmologists more commonly than in previous years. Complete medical histories should be taken before prescribing methazolamide to patients. HLA typing should be conducted whenever possible to screen patients before prescription of methazolamide.

Purpose: To report three consecutive cases of methazolamide-induced Stevens-Johnson syndrome. Case summary: We describe three patients who were all prescribed methazolamide for treatment of ophthalmologic conditions. A 29-year-old man and a 47- year-old woman were prescribed methazolamide (100 mg/day) for the treatment of central serous chorioretinopathy (CSCR). A 66-year-old woman was prescribed methazolamide (100 mg/day) for acute glaucoma of the left eye for approximately two weeks. After taking the methazolamide, three patients were showed the pururitic maculopapular rashes on the whole body and the vesicular eruptions of the oral mucosa and conjunctiva. On the basis of medication histories, characteristic skin lesions and mucosal involvement, we diagnosed all three patients with methazolamide-induced Stevens-Johnson syndrome. All three patients were hospitalized and treated with intravenous steroids and antihistamines. Two of the three cases showed conjunctival pseudomembranes. In two cases, the skin lesions worsened during the first week of treatment, and then resolved without complications over the next two to three weeks. The condition of the 47-year-old female patient deteriorated rapidly to toxic epidermal necrolysis due to sensitivity to sulfa antibiotics. HLA- A24, B59 and Cw1 were detected in all three cases. Conclusions: In 2008, domestic production of acetazolamide was halted in Korea. Because of this, methazolamide is expected to be prescribed by ophthalmologists more commonly than in previous years. Complete medical histories should be taken before prescribing methazolamide to patients. HLA typing should be conducted whenever possible to screen patients before prescription of methazolamide.